Smoking Tied to Knee Revisions

Another reason to quit or not to start. Smoking is associated with a threefold risk of revision after knee replacement. Smoking is THE most important factor associated with an increased risk of revision following total knee arthroplasty (TKA), according to MedPage contributing writer, Pam Harrison.

A study conducted at the Hospital for Special Surgery in New York and led by orthopedic surgery resident and former Harvard Medical School research associate, Benedict Nwachukwu, M.D., MBA, reviewed data for 436 patients who had undergone TKA over a 13 year period.

Men were more likely to have had a revision than were women but old age was associated with a 17% lower risk of requiring a revision, for each five-year increment increase in age.

The mean age of the patients studied was 57.8 years while that for the controls was 65.4. Osteoarthritis was the predominant reason given for a TKA in both study groups. Infection was the most common reason for revision at 30% followed by aseptic loosening at 18%, stiffness at 18%, and instability at 13%.

According to Harrison, the researchers noted that cigarette smoke has been shown to disrupt osteointegration, which is a fundamental process in the longevity of implanted materials. Nicotine has also been found to inhibit secretion of tumor necrosis factor-alpha, another critical cytokine for bone remodeling.